Sierra Leone Health and Biomedical Research Association

REPORT Theme: “Exploring determinants of health in Sierra Leone”

5th Annual Research Symposium 20th to 22nd March 2013, Hill Valley Hotel, Freetown

Introduction

Short presentations were combined with hands on group work in small groups facilitated by experienced researchers. Each group worked on one topic which they used for both the abridged proposal and the abstract.

Although research for health is in development in Sierra Leone, guided by (draft) policy and strategy, many challenges remain, especially in the areas of research for health capacity, funding and utilization of research results. The Sierra Leone Health and Biomedical Research Association (HBIOMED-SL) strives to build capacity and provide a networking and sharing platform for research for health in Sierra Leone. The association is a mix of researchers, health professionals, students and others with an interest in research for health in Sierra Leone. The annual research symposia are the highlight of the HBIOMED-SL activities. The central theme of the 2013 HBIOMED-SL symposium was “Exploring determinants of health in Sierra Leone”. The meeting had 2 keynote addresses by Mrs. Marion Koso-Thomas (a Sierra Leonean working in the National Institutes of Child Health and Human Development, USA) and Mr. Roeland Monasch (UNICEF representative in Sierra Leone) on the theme. Seven (7) sessions and one (1) panel discussion took this theme further in six major areas: Malaria, Lassa fever, Mother and Child Health, Student participation in research, HIV, and Fever of unknown origin. 44 students and 85 researchers attended one or more days of the pre-symposium workshop and the two main symposium days.

Group work in workshop Mr. Rashid Ansumana and Professor Aiah A. Gbakima gave a short presentation on development of abridged proposals and abstracts respectively. The group work was explained by Dr. Heidi Jalloh-Vos. The morning and afternoon sessions were both closed with short presentations of proposal and abstracts developed.

This report summarizes the fifth annual symposium as well as the pre-symposium workshop on abridged proposal and abstract development and presentation. Pre-symposium workshop: Abridged proposal and abstract development and presentation – 20th March 2013

Presentation of proposals/abstracts The participants (44 in number) were very enthusiastic about the participative group work approach and requested repeats and follow-ups in the future. The majority of participants indicated in the evaluation at the end of the day that they gained new skills and knowledge during the workshop.

This workshop equipped the participants with knowledge and skills to develop and present abridged proposals and abstracts. The participants were students who study subjects related to determinants of health.

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Day One of the symposium– 21st March 2013

For example on the cyclic nature of the cholera outbreaks in Sierra Leone, the socio-cultural beliefs that impact care seeking, treatment choices and waste management and sanitation. She also wondered if there are genetic factors that affect susceptibility in relation to possible new strains. Other unanswered questions are the possible role of vaccination programs, the effectiveness of outreach efforts and the usefulness of telehealth in epidemics. Frameworks and Log frames help understand the different aspects of one issue, and the impact and relations of a variety of determinants She advocated for a Strategic Approach (2011 World Congress on Social Determinants of Health) with research that not only focuses on defining the determinants relevant to the Sierra Leone context but explores models and adopts successful mechanisms from countries with similar profiles will be pivotal to create significant improvements in our health. She then summarized that determinants of health are myriad and may not be the same as determinants of health inequity. Exploring these determinants will require a multifaceted approach, for which tools are available, although cause-effect relationships are complex. Case studies from Kenya, Tanzania and other SSA countries show that prioritizing is critical and the ultimate goals should be improved health outcomes.

The symposium with the theme: “Exploring determinants of health in Sierra Leone” started on the 21st of March 2013 with opening prayers, welcome and introductions by Dr. Heidi JallohVos, Vice-Chair of the Sierra Leone Health and Biomedical Research Association (HBIOMED-SL). Keynote Address: “Pandora's Box - An insight to factors that impact health” Dr. Marion KosoThomas, J. William Fulbright, Scholar, Program Officer, National Institutes of Child Health and Human Development, Bethesda, USA Dr. Koso-Thomas defined determinants of health as the combined effect of a range of personal, social, economic and environmental factors which determine the health status of individuals or populations. There is a conglomeration of factors that are associated with determinants of health, the big five; genes & biology, health behaviours, medical care, total ecology and social/societal characteristics. When you look further this opens a Pandora’s box and the big 5 can be broken down further to daily risks that can biological, personal, social, physical, social service and/or policy related for example age, gender, genetic factors, family structure, employment, diet, transportation, culture, religion, peers, air, water and housing. She used the cholera epidemic in 2012 as an illustrative example of determinants of health. Factors that contributed to this epidemic were: inequity (poverty), water supply, overcrowding (access to sanitation), floods and change in rainfall patterns, vulnerable populations and possibly a new strain of cholera? There were multiple factors that contributed to the resolution of the epidemic such as education (particularly campaigns against cholera), behaviours including social mobilization, provisions for waste / sanitation improvement, access to health care, service delivery including training. She stated that if you don’t have public service and policy you will have worse outcomes. She mentioned several unanswered (research) questions in relation to the cholera epidemic.

Dr. Marion Koso-Thomas during her address

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Session One: Malaria – Moderated by Dr. Amara Jambai, Director Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown

Dr. Smith explained about the LLIN universal coverage campaign in November 2010, when Sierra Leone distributed over three million longlasting insecticide-treated nets (LLINs) with the objective of providing protection from malaria to individuals in all households in the country (100% of total population to have LLINs and 80% of population to sleep under LLINs). Six months after this mass distribution campaigns a nationally representative survey was conducted in June/July 2011 to evaluate its impact on household insecticide-treated net (ITN) ownership and use. A two-stage cluster sampling design was used. Factors associated with household ITN possession and uses were examined with logistic regression models. 63.8% of households received LLINs from community distribution point, 20.6% from a government health facility, 13% from a community health worker, with only few receiving from retail shop, private facility, pharmacy, and workplace or other. Ownership of at least own LLIN was higher in Kailahun, Bombali and Western Area Rural, with ownership in rural areas being greater than in urban areas. Overall 87% of households owned at least one LLIN. 68% of household members slept under an LLIN a night before the survey, with 73% of children and 77% of pregnant women sleeping under an LLIN. Children and pregnant women in the lowest and middle wealth quintiles were more likely to sleep under LLIN then the ones in the highest wealth quintile. Wealthier households are less likely to own an LLIN, while middle wealth quintile households are most likely to have at least one LLIN. The survey shows that the 2010 was highly effective at increasing ownership and use of LLINS as a trend analysis shows an enormous increase of LLIN ownership/use from below 10% (MICS2005) to around 30% (DHS 2008) to over 70% (2011 survey) for all groups (U5, PW sleeping under LLIN, households owning LLIN). Dr. Smith mentioned that action is needed to increase possession and use in Western Area, and to close the urban-rural gap for LLIN ownership and use, and to close the gap in relation to ownership and utilization among

Presentations: Presumptive self-diagnosis of malaria and other febrile illnesses in Sierra Leone, Mr. Rashid Ansumana, Mercy Hospital Research Laboratory, Bo Mr. Rashid Ansumana explained in Sierra Leone overuse / inappropriate use of antimalarials and antibiotics is prevalent due to medications being readily available with a study in April 2009 showing that 50.8% malaria drugs were dispensed without a prescription. The objective of his study was to evaluate prevalence of selfdiagnosis of malaria and other febrile illnesses in Bo, Sierra Leone. A cross-sectional survey was conducted in all households in two neighbouring sections in Bo city using questionnaires and spatially-directed surveying methods. The study found that the majority of febrile illnesses in Bo are self diagnosed (66%) without clinical examinations or laboratory testing, including more than half of suspected malaria cases (59%) that are treated presumptively, which is similar to other studies in West Africa. The study limitations were that no laboratory tests were conducted to confirm self-reported causes and no questions were asked about use / preference for drugs. Future studies are recommended in the areas of common types of infection in the population, pharmaceutical access and habits of local residents and knowledge, attitudes, beliefs, practices and behaviours regarding febrile illness. Household Possession and Use of InsecticideTreated Mosquito Nets in Sierra Leone 6 Months after a National Mass-Distribution Campaign November, 2010, Dr. Samuel Juana Smith, Program Manager, National Malaria Control Program, Ministry of Health and Sanitation, Freetown

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children above 5 years and adolescents. Other study results are expected from the KAP survey (February 2012) and the Malaria Indicator Survey (January 2013). Targeting might be needed in future campaigns (larger households, urban areas, and those without a young child or WCBA) to ensure universal access and use.

timely information on the emergence of any treatment failures could be reported. Prevention of malaria by Sierra Leoneans: A myth or reality, Dr. Lynette Palmer, Blue Shield Medical Services, Freetown Dr. Palmer presented on research conducted in her family practice out-patient clinic to determine if patients who presented with malaria recognized personal preventive methods of malaria. This research was conducted against a background of endemic malaria in Sierra Leone with 45% of OPD cases having malaria, nation-wide mass free distribution of bednets in 2010 and free RDT and malaria drugs available at government health facilities and some private health facilities. However she observed that there was no apparent decrease in case presentation, severe cases still remain common and complications are still present at outpatient clinics. Her prospective study started in September 2012 for a period of 18 months and is still ongoing. Up to the 31st of January 2013 there were 168 study participants, with the mode in the 20-29 age range, of which 91 did not use prevention against malaria, 45 used multiple methods and 32 used a single method. Only few used 3 or 4 methods. Most used method was insecticide spray (38), followed by window screen (35), permeated net (33) and mosquito coil (25). The most used single method of prevention was insecticide. The most used combination was bednet with window screen. The malaria parasite count ranged from 80-46,000 micro litres, with most at 2000 or less. Three of the patients with > 20,000 parasite/litre used preventive methods (1 net, screen and coil and 2 only net), while two of the patients with >10,000 used preventive methods (1 net&coil and 1 screen). So far the study shows that most people do not make a personal effort to prevent themselves from malaria, and if they do insecticides is the preferred method. Use of net is not common, even though they are widely available. Frequency of use of methods was difficult to establish form the patients. It is

Assessing efficacy of two Artemisinin-based combinations in the treatment of uncomplicated falciparum malaria in four (4) District Hospitals in Sierra Leone, Lt. Col. (Dr.) Foday Sahr, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown Malaria is major cause of morbidity and mortality in Sub-Saharan Africa and Sierra Leone. Failures with artemisinin monotherapy have been reported (Sahr et al 2011). Limited data suggests failed treatment to combined treatment (ACTs) is rare (Sahr et al 2009). There has been no nationwide survey to monitor the efficacy of the ACT in Sierra Leone since the introduction of ACT as recommended first line treatment in 2008. The objective of this study was to assess to assess the therapeutic efficacy of oral Artesunate-amodiaquine and oral Arthemether-lumefantrine combination therapies in the treatment of uncomplicated falciparum malaria corrected for PCR analysis in children under 5 years in four (4) District hospitals in Sierra Leone. 320 children below 5 years were enrolled in the study. Post corrected PCR cure rates showed a 100% Adequate Clinical and Parasitological Response for both study drugs in the four study sites on day 28. This shows that both oral Artesunateamodiaquine and artemether-lumefantrine are highly efficacious in the treatment of uncomplicated falciparum malaria in Sierra Leone and emergences of resistant strains of the parasite to the two drugs are yet to appear. It is therefore recommended that the ministry of Health and Sanitation undertakes continuous monitoring of the efficacy of these drugs so that

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recommended that the general public is educated on the importance of personal prevention.

historical reports (55% for untreated and 5-30% for treated). The study demonstrates a trend toward decreased mortality amongst treated patients, particularly for those presenting in the acute viremic stages of LF. Those with prior LASV exposure (Ag-/IgM+) or non-Lassa febrile illnesses (Ag-/IgM-) did not show any survivorship benefit from ribavirin. Due to intermittent shortages, ribavirin treatment was not available to all patients determined by a physician to be in need of treatment. The results underscore the need for more thorough studies of ribavirin therapy to establish guidelines on the use of ribavirin for treating LF patients.

Session Two: Lassa Fever - Moderated by Prof. Aiah A. Gbakima, Chair HBIOMED-SL. Efficacy of Ribavirin Therapy in Lassa Fever, Dr. Donald S. Grant, Kenema Government Hospital, Kenema Lassa fever (LF) is an acute and frequently fatal illness endemic to West Africa and caused by the arena virus Lassa virus with as natural reservoir the multimammate rat and primary mode of transmission exposure to its excreta. There are an estimated 300,000 to 500,000 incident Lassa Fever cases annually. Diagnosis is through PCR, ELISA or virus culture. Case fatality rates can reach 50% and up to 90% in pregnant women. Previous studies show that ribavirin is efficacious in reducing LF case fatality rates. Increased risk of death is associated with presenting > 7 days post illness onset (as ribavirin is less effective after 6 days postsymptom onset), with AST>150, in third trimester of pregnancy and with bleeding symptoms. The objective of this study was to determine at the Lassa fever ward (LFW) in Kenema Government Hospital (KGH) whether ribavirin is efficacious or detrimental for specific classes of suspected LF cases: Acute, viremic LF patients (Ag+/IgM+ or Ag+/IgM-), Post-acute LF (Ag-/IgM-) and Non-acute (Ag-/IgM-) as determined by ELISA. At the study site the treatment decision is based on clinical presentation with limited guidance from LF test results. This study was retrospective using 1,229 patients presenting between January 2009 and December 2012. Ribavirin treatment status could be attained for 160 patients. LF patients mostly resided in the endemic LF area near Kenema Government Hospital. Due to small sample sizes, no significant differences in mortality were observed between treated and untreated groups for any of the test result combinations with a CFR among Ag+ patients of 59% for treated vs. 66% for untreated. CFR for treated patients at KGH LFW is higher than

Epidemiology of Lassa Fever in Post-Conflict Sierra Leone: Seasonal Demographics, Mr. Augustine Goba, Kenema Government Hospital, Kenema Lassa fever (LF) is an acute and often fatal illness that is endemic in the West African countries of Sierra Leone, Liberia, Guinea, and Nigeria. Lassa virus (LASV), an arenavirus, is transmitted to humans by Mastomys natalensis, a ubiquitous rodent in sub-Saharan Africa. Kenema Government Hospital (KGH) in eastern Sierra Leone maintains a 25-bed Lassa ward where up to 600 suspected LF cases are seen yearly.

Mr. Goba presenting on Lassa Fever At the KGH, our team has developed a new class of LF diagnostics, including antigen (Ag)capture enzyme-linked immunosorbant assays (ELISAs) and lateral flow immunoassays (LFIs) to detect LASV viremia, and immunoglogulin M

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(IgM)-capture ELISAs to detect convalescent or prior LASV infections. Confounding factors for LF seasonality are considered to be access to health care (in relation to seasonal fluctuations in income) and environmental factors: land use practices, housing quality and impeded travel during rainy seasons due to poor road quality. To assess the seasonality of LF, diagnostic test results for suspected Lassa patients (n=1,207) presenting to the KGH from 2008 to 2011 were analyzed. 94% of samples were from patients residing in Bo, Kenema and Kailahun districts, with obvious reporting bias due to overrepresentation of in areas with active Lassa Fever outreach and unreported cases (from other areas). 72% of all suspected cases were negative, over 70% of observations showed no evidence of current or recent LF infection. Acute, viremic LF cases (Ag+/IgM±) peak in March) which is likely due to environmental and occupational factors with increasing contact with rodents. The increasing trend among Ag/IgM+ observations from early to mid-rainy season followed by an abrupt decline suggests that recent Lassa infection predisposes patients to other febrile illnesses that manifest during rainy season. Sierra Leone would greatly benefit from LF seroprevalance studies. Best approaches for reducing LF incidence will simultaneously consider vaccine development and rodent control. Human/rodent contact can be minimized by identifying and rank-ordering intermediate factors that influence human x rodent interaction, and educating SL’s general public on these findings.

transmission between humans occurs through direct contact with infected blood or bodily secretions. Nosocomial outbreaks have been described in endemic areas including Sierra Leone. The purpose of this study is to develop a specific Geographical Information System (GIS) applied to LF research and survey in Sierra Leone (SL) and to use the “LF/SL/GIS” to establish a Lassa fever risk map. The study will use the actual clinical/epidemiological database available on patients that has been developed by the Lassa fever Project team in Kenema Hospital from 2006 to date. The expected results are live mapping of LF incidence, identified risk factors and temporal and spatial analysis of LF dynamics including epidemiological pattern(s), risk of occurrence /re-emergence, risk of extension/emergence. Preliminary results show concentrations of referred patients in the east. Confirmed cases of LF are all over SL but the majority of confirmed cases and lethal cases are in the southeast. Koinadugu district in the North has a high risk chiefdom. Limitations are Patient Age Accuracy, Patient Mobility & changing demographics and the spatial data of digitalized map, scale available & villages’ geographical coordinates. Concluding, Lassa Fever remains a highly prevalent Viral Hemorrhagic Fever in Sierra Leone where preliminary GIS maps indicate potential risk among all districts. Constant survey will provide new data aiming to develop a live warning system Session Three: Maternal and Child Health Moderated by Dr. Samuel A. S. Kargbo, Director Reproductive and Child Health, Ministry of Health and Sanitation, Freetown

Spatial and timely analysis of Lassa Fever incidence in Sierra Leone, Mr. James Bangura, Metabiota Sierra Leone, Kenema

Use of Government services for children under 5 with fever following user fee removal: a cross-sectional survey, Dr. Sandra Lako, Welbodi Partnership, Freetown

Lassa Fever (LF) is an acute and sometimes severe viral hemorrhagic illness endemic in West Africa. Humans are exposed to Lassa virus primarily through contact with contaminated excreta of the rodent Mastomys natalensis, which is the natural reservoir. Secondary

Sierra Leone has poor child health indicators, with an under five mortality rate of 185 per 1000 live births. In 2010, the Free Health Care Initiative (FHCI), removed user fees for under fives, pregnant and breastfeeding women,

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alongside improvements in human resources, drugs and monitoring. The objective of this part of the mixed-method study with 210 participant questionnaires was to estimate treatment seeking behaviour by caregivers of under fives with fever and its direct costs, two years into FHCI. Majority of care-givers were female (98%) with a mean age of 29 years. 50% of under fives with fever were first treated at home (e.g. with paracetamol). 1/3 used government services and 1/3 used a private provider or pharmacy. In more than half of the cases “free” government services resulted in direct costs to the caregiver, mostly due to stock-outs of free medication. 94% of caregivers sought treatment for the fever and 96% of these did so within 48 hours. 28% of these caregivers went on to a second treatment, while 27% went on to a third. Despite 92% of caregivers reporting awareness of FHCI, only 20% used Government facilities first and only 29% used them at any time during the episode of fever. Of those using government services, 65% used the government clinic within 0.5km of their household. Caregivers who used more than one treatment were less likely to use self-treatment second than first; they were more likely to use a formal provider second than first. 84% of caregivers seeking treatment reported direct costs, with a mean total cost per episode for all treatment choices of USD 2.89, with mean medication costs of USD 2.55/ 54% of those using Government services reported direct costs, with a mean total of USD 1.86, around two times the average daily wage. 34% reported paying for medication (mean total USD 2.0) and 16.4% reported paying consultation fee (mean total USD 1.3). Limitations of this study are that the study population is an urban community close to multiple healthcare providers and results cannot be extrapolated to other populations. There might also be underreporting of traditional and informal sources of treatment. Concluding, two years into FHCI, utilization of Government services for the treatment of fever in under fives remains low, even within a community close to ( 90%. Retention was measured by missed visits, and participants were considered retained if they attended all their visits. Treatment interruptions due to delays in clinic attendance were measured comparing home-based pill counts to refill dates and defined as at least a 48-hour period without taking any pills. Of the 111 participants enrolled, 11 were lost to follow-up, 4 died, and 1 withdrew. 95 participants were followed for 3 months. In the control group, 61.7% of participants adhered to ART, and 76.5% were retained in care. 69.2% had at least one treatment interruption due to delays in clinic attendance (mean=5.3 days later than scheduled). In the intervention group, 56.6% of participants adhered to ART, and 79.2% were retained in care. 62.8% had at least one treatment interruption due to delays in clinic attendance (mean=5.0 days later than scheduled). There was no significant difference in adherence, retention, or interruption outcomes between groups. SMS reminders prior to HIV clinic appointments did not improve adherence or retention outcomes when added to weekly SMS adherence reminders. Further work needs to be done to understand which type of patients may benefit most from this intervention and qualitative work needs to be done to understand the reasons that the patients are late for their appointments.

Questions from the audience Session Six: HIV - Moderated by Dr. Brima Kargbo, Director, National Aids Secretariat, Freetown Text message reminders prior to HIV clinic appointments do not improve adherence to ART or retention in care when added to weekly text message reminders in rural Sierra Leone: a randomized controlled trial, Dr. Daniel Kelly, Wellbody Alliance, Koidu Town In sub-Sahara Africa, weekly short message service (SMS) reminders have improved adherence to antiretroviral therapy (ART), but

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It seems that reminding the patient does not seem to be the issue at hand, phone calls would allow for patient-centred problem-solving and perhaps more comprehensive case management. This is the proposed benefit of a CHW program.

over their HIV care, and 3) internalized stigma, hopelessness, and mental distress make patient perceive clinic attendance as a risk. The majority of patients who were LTFU during pre-ART care stopped care rather than selftransferring to another health facility. Financial constraints, competing demands, and mental distress were barriers to care. Multiple patients described home-delivery of ART as a way to eliminated all of the described barriers. There are various thoughts on implementing this. The home-delivery could be part of the tracer’s job description, and/or community health workers could be used. To select patient for this service a risk assessment tool for newly diagnosed patients could be used, also including patients with a history of LTFU.

People who were traced after being lost to follow-up during pre-ART care are more likely to stop care than self-transferring to another health facility, Dr. Sulaiman Conteh, National Aids Secretariat, Freetown Few studies have traced people who were lost to follow-up (LTFU) during pre-ART care. Mixed-methods tracing study was conducted of people who were LTFU during pre-ART care. This population was established from a prospective cohort of 348 persons newly diagnosed with HIV infection receiving care at Connaught Hospital in Freetown, Sierra Leone. Pre-ART care was described as the period from HIV diagnosis to ART initiation. LTFU was defined as not having attended a clinic visit in the last 150 days. People who were LTFU during pre-ART care were traced as per standard of care, which involved ascertaining their vital status and reasons for being LTFU. A purposive sample of tracing visits included 21 taperecorded interviews. Interviews were transcribed and thematically coded by two independent readers. 130 of 348 (37.4%) patients were LTFU during pre-ART care. 90 of 130 (69.2%) patients were traced, and vital status was ascertained in 87 of these persons (96.7%). 22 of 87 (25%) were dead. Of the 65 persons who were alive, additional outcomes and reasons for LTFU were determined in 38 persons. 2 of 38 persons selftransferred their care to another health facility, and 26 (68.4%) stopped care. 15 of the 21 (71.4%) interviews were conducted with persons who stopped care. Multiple themes emerged from interviews and explained why people were LTFU: 1) financial constraints limit their ability to take transportation to clinic, 2) competing demands such as child care, school studies, work, and food security are prioritized

The Origins of AIDS and Newly Emerging HIV-2 in Sierra Leone, Professor Preston A. Marx, Tulane National Primate Research Centre, Covington, LA, USA In the mid 20th century Simian Immunodeficiency Viruses (SIVs) from sooty mangabeys in West Africa crossed the species barrier to humans to become Human Immunodeficiency Virus type 2 (HIV-2). The epidemic subtypes of HIV-2, A and B, have circulated in the human population for approximately 50 years. However, because of exposure to SIV infected sooty mangabeys from contact with household pets or bush meat, it is possible that new strains of SIV could infect humans in West Africa leading to outbreaks of new HIV-2 subtypes that may pose new risks. HIV-2 subtype F was discovered by the Marx group in the early 1990s in northern Sierra Leone in the Kabala region. HIV-2F was found to be closely related to sooty mangabey SIVs found in Sierra Leone and it may represent a recent cross-over of a new SIV to humans. The virus, named HIV-2SL93F, [HIV-2 Sierra Leone 1993 subtype F], infected a woman who was lost to clinical follow-up during the war. Until recently she was the only person known to be infected with HIV-2 F and it was assumed to be

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a limited outbreak. Here we report the isolation of HIV-2 subtype F [HIV2-NWK08F] from an immigrant to the USA. This male patient was from Kabala and had evidence of immune suppression. Data were collected from the patient and his medical chart. Informed consent was obtained. HIV2-NWK08F [Newark, New Jersey, USA 2008 subtype F] was isolated using standard HIV coculture techniques. Quantitative PCR was performed with env primers and probe with an ABI Prism thermocycler. The viral genome was sequenced to determine its relationship to HIV2SL93.

env and gag were successfully amplified. Phylogenetic analysis showed HIV-2-NWK-08F clusters most closely with HIV-2SL93F and next most closely with 2 SIVs found in sooty mangabeys in Sierra Leone. These data show that a new pathogenic strain of HIV-2 is circulating at least within Sierra Leone. Health care providers in Sierra Leone and elsewhere should be alerted that a strain of HIV-2, which is not detected by PCR for epidemic HIV-2 subtypes, exists and can lead to immunosuppression. However HIV-2 Western blot can be used for diagnosis. Epidemiologic studies are required to determine the extent of this virus’ spread in Sierra Leone and to other countries. Session Seven: Other - Moderated by Dr. Jarrett, Department of Sociology, Fourah Bay College, University of Sierra Leone, Freetown Addressing the Consequences of War through an Intervention to Improve Emotion Regulation, Prosocial Skills and Functioning in War-affected Youth: a Randomized Controlled Trial, Dr. Theresa S. Betancourt, Harvard School of Public Health, Boston, USA

Professor Marx presenting In 2008 Patient X was a 68-year-old male from Freetown, Sierra Leone. He had moved from Kabala to Freetown. Patient X immigrated to Newark, New Jersey, USA in 2007. Patient X’s serum was repeatedly reactive by serological testing with ELISA kits containing HIV-1 and HIV2 antigens. The HIV-1 western blot and viral load were both negative [60% of Kono HWs not able to communicate with supervisor at all and close to 80% not able to advocate with supervisor. 59% of Kono HWs do not have a positive relationship with clients at all. 97% of Kono HWs report rarely or never receiving recognition from supervisors, while 96% of HWs report that the community never or rarely respects them. Kono HWs had negative assessments of their job performance in all sectors with 94% saying they were not all or rarely able to provide quality care and 83% saying they were not at all or rarely able to use their abilities and skills to do their job well. 75% of Kono HWs responded that they often feel stress in their job, with 65% of HWs responding that they cope poorly with the stress in the workplace. In Kailahun district it was found that poor and dysfunctional relationships between TBAs and PHUs, PHUs and community, and TBAs and community represent over half (51%) of the challenges cited by health providers. While relationships were a major theme among both groups, TBA and PHU relationships, and provider and community relationships were a much greater concern for TBAs. It is clear that factors beyond financial incentives effect job motivation, satisfaction, and quality of care. Respect, recognition, and positive relationships with the community, with colleagues, and with supervisors are key. This indicates that there is potential for low or nocost interventions in reducing barriers to MNCH care in Sierra Leone and further indicates the need to consider the importance of nonfinancial factors in our interventions and policy in this area. The two pilot initiatives to respond to above results are Helping Health Workers cope (Kono District, 271 PHU staff, 75 PHUs, 12 chiefdoms, psychosocial group and individual counselling) and Quality circles (Kailahun district, 55 PHU staff and 297 TBAs, 14 chiefdoms, Quality improvement circles that

Health workers define key challenges to job motivation, performance and quality of care: Evidence from two districts in Sierra Leone, Ms. Emily Cummings, Concern Worldwide Innovations for Maternal, Newborn & Child Health, Freetown In 2009, Concern Innovations carried out a study to better understand the biggest barriers to coverage of high impact MNCH interventions. The biggest barrier that was identified was that people feel that health workers perform poorly, have low motivation to help and have poor attitudes. Health workers feel that they are not supported and asked to work n difficult circumstances. Concern implemented a nationwide campaign to collect “new ideas” to address this barrier. 3 winning ideas, all focussing on quality improvement began implementation in 2011. To inform project design, additional research was conducted to understand the challenges of the target beneficiaries. 271 MOHS PHU staff were interviewed in Kono district using a standardized quantitative clinical assessment tool. Focus group discussions were held with 155 MOHS PHU staff and 297 TBAs in Kailahun district using standardized qualitative tools.

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provide peer-learning, per-support and joint problem solving).

participated in 4153 surgical procedures in 8 hospitals either as observer (24.6%), assistant (39.1%), surgeon direct supervision (14.8%) or surgeon indirect supervision (21.5%). The three most performed procedures were inguinal hernia repair (29.1%), caesarian section (16.2%) and explorative laparotomy (6.4%). In conclusion the surgical training program is increasing the surgical capacity in Sierra Leone by training medical doctors and community health officers in basic life saving surgery using the concept of task-shifting in surgery widely used in East Africa. The first 2 students have completed their training and have passed the exam. Every 3 months 2 students enrol in the program. At the end of 2013 2 students will start working in the district hospitals. The expectation is that by 2017 35 students will have finished the training.

The Surgical Training Program: Increasing surgical capacity in Sierra Leone by training Medical Doctors and Clinical Officers in surgical skills – Status Update After 2 Years. Dr. Alex J. van Duinen, Masanga Hospital, Masanga Background: Surgical and obstetrical emergencies are poorly addressed in Sierra Leone. Lack of human resources is a main contributing factor with only 14 surgeons, 7 Obstetrician/gynaecologist, 5 Medical doctors practising surgery and 14 surgical technicians in the whole country, with the majority based in Freetown. A 2012 countrywide community survey (n=3645) shows that 37% reported a surgical condition, 31% reported at least one household member dying in the previous year and 33% of deaths were associated with a surgical condition that might have benefited from surgical care. It is clear from this that there is a large unmet need for surgical interventions. Surgical Care is cost effective (USD 11-33 per DALY averted as compared to USD 5 for measles vaccination and USD 300-500 for ART for HIV). Surgical Task-Shifting experience from EastAfrica learns that 80-90% of caesarean sections in several countries are now done by Non Physician Clinicians and that retention of these staffs is high and there are no significant differences in maternal and perinatal death. The Surgical Training Program aims to increase the surgical capacity in Sierra Leone by training medical doctors and community health officers in basic life saving surgery and obstetrics, having a strong cooperation with the MOHS, creating a strong network together with 8 other hospital and using the example of surgical taskshifting from East Africa. In December 2012 14 students (1 MD, 13 CHOs) had enrolled in the program; 2 dropped out, 3 are in basic training in Masanga (first 6 months), 7 are in partner hospitals (second part of the training) and 2 have graduated and started with houseman ships. students are enrolled after two years, 1 MD and 15 CHOs. All students have

Contribution from the audience Hospital Survey on patient safety culture (HSOPS) in 2 tertiary hospitals in Freetown, Sierra Leone, Mr. Osman M. Koroma, Johns Hopkins University School of Medicine, Baltimore, USA Research has shown a strong correlation between safety culture in hospitals and patient outcomes. The Johns Hopkins Austere Anesthesia Health Outcomes Research Group (JH-AAHOG) mission is to provide relevant, appropriate and sustainable solutions to improve anaesthesia and peri-operative care in austere environments. They are currently conducting studies at Connaught Hospital and Princess

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Christian Maternity Hospital (PCMH) in Freetown. The objective of these studies is to assess the perception of institutional patient safety culture among perioperative staff in 2 tertiary hospitals in Sierra Leone, using the Hospital Survey of Patient Safety (HSOPS). The HSOPS is a validated survey that has been used in different settings in many countries. The HSOPS assesses several cultural dimensions affecting patient safety (e.g. teamwork, communication openness) Questions were appropriately modified to be relevant to perioperative care and rephrased for ease of comprehension. Over a one-month period (Sept-Oct 2012), the survey was administered to samples of the staff involved in perioperative care: surgeons, anaesthesia staff, perioperative nurses and technicians, and ancillary staff: cleaners, porters and security staff. There were 63 respondents at Connaught hospital and 78 respondents at PCMH. The percentage of positive responses for questions in each dimension was quite similar between both hospitals. Aspects with less than 50% were: Non-punitive response to errors, Handoffs & Transitions, Staffing and Frequency of events reported. In both hospitals approximately 40% of the respondents had reported a safety deviation in the past year. In both hospitals, teamwork within units had the highest average positive responses (91% Connaught, 81% PCMH). At the Connaught hospital and at PMCH respectively 80% and 76% of the theatre staff felt that mission teams collaborate well with local health care providers, and 92% and 79% respectively agreed that they had learned useful skills as a result of medical missions. At the Connaught and PMCH respectively 67% and 68% said medical missions offer high quality care during their trips to the hospital. At Connaught and PMCH 77% and 62% respectively felt that the medical equipment at their disposal was less than adequate. 11% of theatre staff at Connaught and 17% at PMCH feel that it is difficult to discuss errors in the OR. The limitations of the study were that significant rates of absenteeism prevented

systematic random selection and the small sample size of certain cadres relative to others. When reflecting on the results the following need to be considered: communication and safe surgery checklist, cultural nuances to interhierarchical communication, misconceptions about punitive response to event reports and anonymous event reporting /suggestions. The conclusion is that organizational culture an important factor that affects patient outcomes. The HSOPS can help identify existing lapses. Addressing identified lapses in staff perceptions can positively impact patient outcomes. The use of mobile electronic devices: using Deki readers for monitoring diseases, Mr. Joseph M. Lamin / Mr. Rashid Ansumana, Mercy Hospital Research Laboratory, Bo The use of rapid diagnostic tests in resource poor settings for the diagnoses of common infections such as malaria, HIV and syphilis is growing especially in very remote settings. Though simple in operation, the correct use of rapid tests is critical in getting clinically relevant results. Additionally, the ease of disseminating results for monitoring outbreaks is important. The goal of our study is to use a mobile electronic device, the Fio Deki Reader, comprised of an android operating system for workflow guidance, automated rapid diagnostic test analysis, data capture and transmission, timely disease surveillance and remote coordination. Rapid diagnostic tests for diagnosing several infectious diseases including malaria, syphilis, hepatitis A, B and C, Dengue, Chikungunya, Typhoid and HIV were used. The tests were done as prescribed in the product inserts and the RDTs were used on the Fio Deki Reader. The Deki reader was connected to a wireless network and its 3G network was also enabled by using an Airtel Sim Card. With the reader connected to the internet, all data uploaded are sent to a cloud database for automatic analyses of results and remote monitoring. Our results show that the FIo Deki Reader works well in Sierra Leone with the 3G network of

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Airtel to upload records for automated analyses, remote monitoring and coordination. Our results support existing evidences that the Fio Deki Reader is good for timely disease surveillance, efficient reporting, monitoring point of care activities and remote coordination.

Training is being continued with external consultants over the next 6 months. In 2012 (October to December) the lab received 89 rectal swabs, of which 7 were positive. In 2013 34 specimens were collected so far, of which 2 were positive. The strain of pathogen that caused the outbreak is V.Cholerae 01, the most common Serovar is V.Cholerae 01 Ogawa, with one case of V. Cholerae 01 Inaba. Limitations of the study were lack of supplies and lack of consistent power supply which caused some problems in continuous testing. The delay between sample collection receipts at CPHRL can be lengthy, particularly for outlying districts, causing bacteria to die, leading to potential false-negative results. Results are consequently reported as ‘Cholera not detected’. There are districts which have not been trained in rectal swab collection. Concluding, the staffs of CPHRL are now competent in the isolation and identification of V. cholerae from rectal swabs, providing a confirmation service for Sierra Leone. Further work is still needed in expanding the bacterial service provided and ensuring that staffs in all the districts are trained in the collection of samples.

Isolation of V. cholera in Sierra Leone, Ms. Fay Rhodes, Central Public Health Reference Laboratory, Lakka. Sierra Leone has previously been unable to isolate V. cholerae as a bacterium from human specimens. Following the cholera outbreak in 2012, WHO and consultants from the Bangladesh, UK and USA worked with the Ministry of Health and Sanitation to train personnel at the Central Public Health Reference Laboratory (CPHRL) in the collection of rectal swabs and the isolation and sub-typing of V. cholerae. Aim of the Enteric Bacteria laboratory at CPHRL is to produce accurate results and send them out to the Directorate of Disease Prevention and Control (DPC) as soon as possible with as objectives to: Enable CPHRL to isolate V. cholerae and other enteric pathogens from rectal swab samples, Train CPHRL staff in health and safety and quality aspects of bacteriology and train medical and laboratory staff in collection of rectal swab samples. Consultants from across the globe came to the laboratory to conduct training. Initially, training was completed at the laboratory in rectal swab collection after which CPHRL staff travelled to the districts to train other staff in the collection of rectal swabs. These swabs are sent to CPHRL for confirmation. At the laboratory, CPHRL staff were trained in the detection of bacterial pathogens, prioritising V. cholerae. Intensive training in new methodology, media preparation and health and safety and quality systems was initially undertaken over the course of one month. Staff was completely new to bacterial pathogens and worked hard to gain understanding and develop testing protocols.

Session Eight: Fever of unknown origin? Moderated by Lt. Col. (Dr.) Foday Sahr, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown Re-emergence of chikungunya virus in Bo, Southern Province, Sierra Leone, Mr. Rashid Ansumana, Mercy Hospital Research Laboratory, Bo Outbreaks of chikungunya virus (CHIKV), an Alphavirus transmitted through the bites of infected Aedes mosquitoes, were frequent in sub-Saharan Africa and in South and Southeast Asia between the 1950s and 1970s, but the infection largely disappeared in the 1980s, with only sporadic cases occurring. The virus reemerged in the early 2000s, with major outbreaks reported in Kenya, some island

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nations in the Indian Ocean, and several Asian countries. The primary symptoms of CHIKV infection are high fever and severe pain in the distal joints of the extremities and/or the lumbar spine. A maculopapular rash, sensorineural impairment, severe headache, and other non-specific symptoms may also occur. The symptoms usually resolve within a week or two of the onset of fever, but for a sizeable proportion of patients the arthralgia and arthritis become chronic and the pain persists for years. A nationwide serosurvey in Sierra Leone in 1972 detected CHIKV cases throughout the country, but we are not aware of any cases reported in the scientific literature since the mid-1970s. Recently outbreaks of reemerging CHIK have been reported from Guinea and Senegal. Recent yellow fever cases in Sierra Leone show that Aedes-borne infections are common/ On July 7, 2012, the Mercy Hospital Research Laboratory (MHRL) in Bo initiated a year-long infectious disease surveillance program that aimed to identify the diversity of pathogens causing febrile illness in the city. More than half of the cases tested during the first week of the surveillance program were LFIpositive for CHIKV. By January 10, 2013, 400 of 932 (42.9%) febrile patients had tested LFI positive for CHIKV. The ages of the 400 CHIKV IgM-positive patients ranged from 6 years to 85 years; 172 (43.0%) were male. Of these 400 patients, 220 (55.0%) reported arthralgia, 189 (47.3%) chills, and 156 (39.0%) headache. Our results suggest that an outbreak of chikungunya virus has occurred in Bo, Southern Sierra Leone. Further studies are ongoing to characterise the virus.

Government Hospital (KGH) Lassa Fever Ward located in eastern Sierra Leone. Of the samples tested, generally only 30-40% are positive for Lassa virus and/or Lassa-specific IgM antibodies; therefore, 60-70% of the patients are presenting with acute diseases of unknown origin. The purpose of this study was to determine the cause of undiagnosed acute febrile illnesses presenting as Lassa fever at the Kenema Government Hospital and to build the capacity to diagnose non-Lassa febrile illness in Sierra Leone. 395 submitted samples (of 253 patients) that were negative for malaria infection, as well as Lassa virus antigen and Lassa virus-specific IgM antibody were evaluated for IgM antibodies to arthropodborne and hemorrhagic fever virus pathogens that could occur in the region and mimic Lassa fever presentation. IgM capture enzyme-linked immunosorbent assays (ELISAs) were used to determine presence of target specific antibodies. Evidence was found for Dengue (4.3 % of patients), West Nile (2.8%), Yellow Fever (2.5%), Rift Valley fever (2.0%), Chikungunya (4.0%), Ebola (8.6%), Marburg (3.2%) and Lassa (IgM, 3%). No evidence was found for CrimeanCongo haemorrhagic fever virus. In total 28.1% of patients had evidence for either an arthropod-borne or a hemorrhagic fever virus. Work on PRNT confirmation is ongoing. The study was limited with the availability of only retrospective samples with little clinical information and no ability for follow-up permitting only presumptive results. There is a need to increase diagnostic capabilities including antigen detection and IgM ELISA, real-time PCR and Lassa lateral flow assays. Other areas of interest could be host markers of infection and pathogen discovery.

Undiagnosed Acute Febrile Illnesses in Sierra Leone, Dr. Randal J. Schoepp, US Army Medical Research Institute of Infectious Diseases, USA

Retrospective Review of Etiologies of Fever Presenting to Kenema Government Hospital in Sierra Leone, Dr. Prerana J. Roth, University of Illinois, USA

The West African country of Sierra Leone is located in a Lassa fever hyper-endemic region that encompasses Guinea, Sierra Leone, and Liberia. Each year suspected Lassa fever infections result in approximately 500-700 samples being submitted to the Kenema

There is limited published data regarding the causes of febrile illness in Sierra Leone. For

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Sierra Leone, it is known that the incidence of tuberculosis was 682 per 100,000 people and that malaria accounted for 35.6% of outpatient morbidity in 2010. This study aimed to use retrospective chart review to describe the demographics, presenting clinical symptoms, diagnostic workup, discharge diagnosis, treatment and mortality of febrile adult patients presenting to Kenema Government Hospital (KGH) between 1 November 2011 and 1 November 2012. Although Lassa ward data were also obtained, they are not part of this preliminary analysis. 787 adult patients (83% male) were admitted during the study period. 47.9% had a chief complaint of fever; 22.5% were documented to have a fever, 13.3% had a documented fever within 24 hours. The most common diagnoses made were malaria (approx 30%), typhoid, gastroenteritis and pneumonia. No diagnosis was made in the majority of patients (50%). Factors associated with mortality were: documented fever, no diagnosis prior to death, low haemoglobin and lower systolic/diastolic blood pressures on admission. 28% of patients with documented fever died in the hospital, while 14% of patients with subjective fever died in the hospital. Of note is that those that died appear to have died within the first 3-4 days of admission. Bacteriology is lacking to aid diagnosis at KGH, no patients at KGH had blood cultures done while bacteraemia as cause of fever is seen in 13-20% of patients in sub-Sahara Africa. Malaria may be over diagnosed as there is a low median parasite density although a Tanzanian study determined a cut-off of 500 in adults and another study from Kenya found that any parasitemia could correlate to clinical disease in adults. Other useful tests for KGH could include sputum culture, TB-PCR, more specific typhoid testing, and CSF analysis. Concluding there is a need to build laboratory capacity to increase the availability of accurate diagnostic testing in order to establish the true prevalence of local diseases, decrease mortality rates through accurate diagnosis and treatment and

developing clinical algorithms based on symptoms that may help guide early treatment. The study is significantly limited by lack of recording of presenting history, vital signs, test results, and discharge diagnoses.

Professor Aiah A. Gbakima giving the closing remarks Summary / conclusion / closing remarks Professor Aiah A. Gbakima, Chair HBIOMED-SL Association Professor Gbakima thanked all for coming to the 5th symposium, which he mentioned was indeed very successful. He thanked the student helpers, key note speakers, moderators, reporters, sponsors, and contributors of registration fees, hotel and kitchen staff and anyone else who made the symposium a success. He gave special thanks to Danielle Levy for taking minutes of the fourth and fifth research symposia. He asked the participants to send any comments and suggestions including topics for next year’s symposium and funding sources to the HBIOMED-SL executive.

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Sponsors of the 5th Symposium UNICEF Sierra Leone METABIOTA TULANE UNIVERSITY

Dr. Lynette Palmer and her student helpers busy at the registration table

Poster presentations 1. World Health Kamara.

Equity,

Jennifer

V.

Meeting outcomes The lessons learned during the symposium included the need to:     

Think out of the box Be innovative Also consider determinants of health that are outside the health sector Continue to include students and motivate them to engage in research Continue to involve (senior) staff of MOHS, Universities, NGOs and other relevant institutions and widen the participation in HBIOMED-SL activities

Next steps The 6th Annual Sierra Leone Health and Biomedical Research Symposium is scheduled for March 19-21, 2014. The theme is: “Health of the Sierra Leone child” Arrangements for the symposium are underway and more details will be communicated closer to the symposium.

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Researcher participants Number 1 2 3 4 5 6 7 8 9 10

First name Janet F Toyin Fuambai Allieu Rashid Tamba Boakye Thomas Mohamed S Kristin

Last name Ahmadu Ajayi Amadu Ansumana Ansumana Ansumana Antwi Ashley Bah Banek

Institution W/FSA Wellbodi Partnership OVP Save the Children Mercy Hospital Research Laboratory Johns Hopkins University Freetown Blue Shield Hospital Masanga Hospital Hellen Keller International London School of Hygiene & Tropical Medicine Metabiota Wellbody Alliance King's Health Partnership Harvard School of Public Health W/FSA Concern Johns Hopkins University Freetown School of Midwifery Makeni Johns Hopkins University Freetown Concern Worldwide School of Midwifery Makeni Solthis Blue Shield Hospital Blue Shield Hospital Catholic Relief Services 34 Military Hospital Johns Hopkins University Freetown Regional Hospital Makeni METABIOTA Lassa Program, Kenema Government Hospital

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

James Mohamed Bailor Abdullah Theresa Jenneh Kristen Adaora Velma B Mariama Emily Fatmata J Nathalie Yusupha Richmond Meredith Yvette E Alpha Hawa Aiah A Augustine

Bangura Barrie Bashir Betancourt Borbor Cahill Chima Cole Conteh Cummings Dabo Daries Dibba Dixon-Cole Dyson Elliott Fawundu Fornah Gbakima Goba

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Donald S

Grant

Lassa Program, Kenema Government Hospital, Ministry of Health and Sanitation

32 33

Jose Katrina

Gutierrec Hann

Catholic Relief Services Harvard School of Public Health/CARITAS Freetown

34 35

Laura Jose

Hastings Hulsenbek

Concern Medicins sans Frontieres - Belgium

Number 36 37 38 39 40

First name Alpha M Sheku Sulaiman Heidi Alfred

Last name Jalloh Jalloh Jalloh Jalloh-Vos Janett

Institution Medical Research Centre

41 42 43 44

Olamide Ben Oliver Abdul

Jarrett Jeffs Johnson Kamara

45 46

Habib Isatu Bosco

Kamara Kamara

University of Illinois at Chicago Medicins sans Frontieres - Belgium King's College London Central Public Health Reference Laboratory, Ministry of Health and Sanitation Helen Keller International Princess Christian Maternity Hospital and School of Midwifery Makeni

47 48

Samuel S Sarian

Kamara Kamara

Kamba Clinic Reproductive Health and Family Planning Program, Ministry of Health and Sanitation

49 50 51 52 53 54

Jabati S Sylvester Brima Dan Osman B Marion

Kanneh Kanneh Kargbo Kelly Koroma Koso-Thomas

Save the Children Central Public Health Reference Laboratory National AIDS Secretariat Wellbody Alliance Johns Hopkins University Freetown National Institute of Child Health and Human Development, USA

55 56 57 58 59

Sandra Joseph M Franck Danielle Margaret T.

Lako Lamin Lamontagne Levy Mannah

Welbodi Partnership MHRL-SL Solthis Tulane University Princess Christian Maternity Hospital (PCMH), Ministry of Health and Sanitation

60 61 62 63

Preston Hilton Amy Jinnah

Marx Matthews McGowan Minah

Tulane University Johns Hopkins University Freetown Welbodi foundation Fourah Bay College, University of Sierra Leone

64 65 66 67 68

Roeland Mohamed Yvonne Gene Lynette

Monasch Nyalley Nzomukunda Olinger Palmer

UNICEF Johns Hopkins University Freetown Medicins sans Frontieres - Belgium US Army Medical, USAMRIID Blue Shield Hospital

Ministry of Health and Sanitation Medical Research Centre Fourah Bay College, University of Sierra Leone

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Number 69 70 71 72 73 74 75 76 77 78

First name Jusufu Fay Foday Marion John Randal J Kadijatu Marie T Halimatu S I Samuel Juana

Last name Paye Rhodes Sahr Sankoh Schieffelin Schoepp Shaw Sheriff Shyllon Smith

Institution Helen Keller International Central Public Health Reference Laboratory University of Sierra Leone Johns Hopkins University Freetown Tulane USAMRIID Welbodi Partnership School of Midwifery Makeni School of Midwifery Makeni National Malaria Control Program, Ministry of Health and Sanitation

79 80 81 82 83 84 85

Mustapha Roland Ify Alex Dayo S Josien Isatta

Sonnie Suluku Udo van Duinen Walters Westendorp Wurie

Helen Keller International Njala University Harvard Masanga Hospital Harvard School of Public Health Masanga Hospital CDC/APHL

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Student participants Number First name 1 Sao K

Last name Amara

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

Bangura Bankole-Gibson Banya Barrie Benya Bockarie Enang Gbessay Gbondo Ikechukwu Jabbie Jalloh Jalloh Jalloh Kamanda Kamara Kamara Kamara Kanu Kargo Labor Lahai Lamin-Boima Lawundeh Macauley Mansaray Manyeh M'bayo M'bayo Nabieu Naveed Nyelenkeh Omobawale Omoloso Penn-Timity Rahman Sankoh

Musa Ryan Sam Sama Hawanatu A Joseph Imourana Eno A Musa Osman Winstona Nnanna Ahmed Abdulai Tejan Mohamed Boie Hassan Samuel Saa Alusine Robin John Samuka Fomba Abu Bakarr Kandeh B Temitayo S Paul Anthony Prince Tamba Albert Melissa June Hannah Paul Tamba Suba Sia Tenema Kumba Mohamed Asad Alie Olopade Olamidotun Marvel Warda Sidikie

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Institution College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone (USL) Njala University COMAHS COMAHS COMAHS Njala University Njala University COMAHS COMAHS COMAHS COMAHS Njala University COMAHS COMAHS Njala University COMAHS COMAHS COMAHS Njala University COMAHS Njala University COMAHS Njala University Njala University Njala University Njala University Njala University COMAHS COMAHS COMAHS Njala University COMAHS Njala University COMAHS COMAHS Njala University Njala University Fourah Bay College, USL

Number 39 40 41 42 43 44

First name Albertina Brima M Francess M T Vamunya Wilma F Gibrilla A

Last name Sesay Sesay Sesay Sesay Tanga Tucker

Institution COMAHS COMAHS COMAHS Njala University COMAHS Njala University

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The Sierra Leone Health and Biomedical Research Association (HBIOMED-SL; http://hbiomedsl.org) was formed as a result of a meeting entitled “Research Day” held on March 21, 2009 at the Conference Hall of the Faculty of Nursing, College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone (USL). Participants at this meeting included Sierra Leoneans and non-Sierra Leoneans interested in research capacity development and the strengthening of bio-medical/bio-behavioural research in Sierra Leone from various institutions working in Sierra Leone, United States, United Kingdom and Europe. A symposium has been held in March every year since 2009. This report is the summary of the 2012 activities. The HBIOMED-SL group can be contacted as follows: Chair Vice chair Secretary Treasurer

Professor Aiah A. Gbakima Dr. Heidi Jalloh-Vos Mr. Rashid Ansumana Dr. Lynette Palmer

[email protected] [email protected] [email protected] [email protected]

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